Episode #22 - The Most Overrated Exercise For Knee Pain

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I feel the most overrated knee pain exercise that you will see in physical therapy clinics all over the globe is the TKE. Which stands for Terminal Knee Extension Exercise.

The 4 reasons why I dislike this exercise is because:

#1) It significantly under loads the quads. The quads are a LARGE muscle group that can stand a lot of stress. As a result under loading them will NOT build strength.

#2) There is no eccentric quad strength developed or loaded. For patellar tendon and quad tendon health an eccentric exercise provides the most physical adaptation to occur on a histological level. As a result, the TKE exercise is best used in acute scenarios or post op cases at best.

#3) It doesn't actually improve knee extension. Sure maybe in post surgical cases initially, but you will not actually improve knee extension significantly using this exercise. Furthermore joint mobilizations don't accomplish as much as you would hope to expect either (outside of post surgical cases). Instead taking an active approach and utilizing muscles to create joint play and control simultaneously is the best route to go. Encouraging anterior and posterior glides using quads and hamstring respectively. As well as encouraging pronation and supination via foot pressure to create rotation at the knee. 

#4) People claim that this exercise resembles gait. However, the knee does not extend when you walk. The heel does not go to the ground when you walk. Instead the foot plantarflexes at toe off. The knee never straightens and stays slightly bent, then moves FORWARD at toe off. Quad dominance creates triple extension and triple extension never actually occurs with any linear based movement such as walking, running, sprinting, jogging, or even jumping when you consider both a horizontal and a vertical force vector!